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Plerixafor is effective given either preemptively or as a rescue strategy in poor stem cell mobilizing patients with multiple myeloma.

AbstractBACKGROUND:
Harvest of more than one CD34+ stem cell transplant has become the standard, to ensure the option for a second autologous transplantation in patients with relapsed or progressive multiple myeloma (MM). Additional administration of the CXCR-4 inhibitor plerixafor has been shown to increase the efficiency of CD34+ stem cell harvest. However, the algorithm when to apply plerixafor is still under debate.
STUDY DESIGN AND METHODS:
In this retrospective study, 46 MM patients were categorized into four groups according to their CD34+ stem cell count in peripheral blood (PB) and mobilization with or without plerixafor: Group A comprised poor mobilizers with CD34+ cell counts of fewer than 20 × 10(6) /L in PB. Group B included inadequate mobilizers with CD34+ cell counts of 20 × 10(6) /L or more in PB and a low CD34+ stem cell yield in the first leukapheresis session. Patients receiving plerixafor preemptively (Group A1) and as a rescue strategy (Group B1) were compared to patients continuing stem cell collection with granulocyte-colony-stimulating factor alone (Groups A2 and B2).
RESULTS:
In both, the preemptive and the rescue settings, plerixafor enhanced the CD34+ stem cell yield significantly. Poor mobilization and administration of plerixafor was not associated with delayed engraftment.
CONCLUSION:
Our data demonstrate that administration of plerixafor is safe and effective and facilitates a significantly higher CD34+ stem cell harvest. Based on the presented data, we propose an algorithm for the use of plerixafor for CD34+ stem cell mobilization and harvesting in poor mobilizing myeloma patients.
AuthorsJian Cheng, Michael Schmitt, Patrick Wuchter, Eike C Buss, Mathias Witzens-Harig, Kai Neben, Michael Hundemer, Jens Hillengass, Renate Alexi, Hartmut Goldschmidt, Bao-an Chen, Anthony D Ho, Anita Schmitt
JournalTransfusion (Transfusion) Vol. 55 Issue 2 Pg. 275-83 (Feb 2015) ISSN: 1537-2995 [Electronic] United States
PMID25117969 (Publication Type: Clinical Trial, Journal Article)
Copyright© 2014 The Authors. Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.
Chemical References
  • Anti-HIV Agents
  • Benzylamines
  • CXCR4 protein, human
  • Cyclams
  • Heterocyclic Compounds
  • Receptors, CXCR4
  • plerixafor
Topics
  • Adult
  • Aged
  • Anti-HIV Agents (administration & dosage, adverse effects)
  • Autografts
  • Benzylamines
  • Cyclams
  • Female
  • Hematopoietic Stem Cell Mobilization
  • Heterocyclic Compounds (administration & dosage, adverse effects)
  • Humans
  • Leukapheresis (methods)
  • Male
  • Middle Aged
  • Multiple Myeloma (blood, therapy)
  • Peripheral Blood Stem Cell Transplantation
  • Receptors, CXCR4
  • Retrospective Studies

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